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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Housing Instability: Pregnancy.

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Strategy. Housing Assistance Programs (Pregnancy)

Approach. Increase pregnant and postpartum women's access to affordable and safe housing to prevent poor birth outcomes.

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Overview. Housing assistance has significant implications for maternal health and well-being. Housing assistance programs, particularly those that provide affordable and stable housing options, can positively impact pregnant women by.. These programs play a vital role in improving birth outcomes as well by addressing housing affordability, stability, and access to essential resources and services.[1,2]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Patient-reported challenges to housing data
  • Housing navigator and case manager activity logs
  • Qualitative feedback from all collaborative partners Client-level housing status documentation
  • Patient-reported challenges to housing data
  • Inter-agency collaboration data Referral and enrollment data for housing support programs
  • Client/family self-reported housing stability metrics
  • Internal staff knowledge and training on housing policies

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of pregnant and postpartum women identified and referred to housing assistance programs supported by Title V. (Measures outreach and engagement of focus population)
  • Number of partnerships led by Title V established between housing providers, healthcare organizations, and community-based agencies to provide coordinated housing assistance and supportive services to pregnant and postpartum women. (Shows cross-sector collaboration and service integration)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of housing assistance programs for pregnant and postpartum women that utilize evidence-based practices. (Measures adherence to best practices in housing assistance)
  • Percent of housing assistance program staff and partners who reflect the communities served and are trained in best practices. (Shows increase in workforce competencies)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of community-wide initiatives implemented to build public awareness and support for increasing access to affordable housing for pregnant and postpartum women that result in an increase in knowledge and/or skill. (Measures narrative change and public engagement efforts)
  • Number of healthcare providers, managed care organizations, and public health agencies collaborating with Title V that incorporate housing stability screenings and referrals into routine prenatal and postpartum care protocols. (Assesses institutionalization and spread of housing as a maternal health priority)
  • Number of neighborhoods and communities that experience reduced rates of adverse birth outcomes and maternal morbidity as a result of tailored housing investments and supports for pregnant and postpartum women. (Assesses community-level impact of housing interventions)
  • Number of cross-sector initiatives and partnerships catalyzed by housing assistance programs to address the intersecting root causes of maternal and child health, such as education, transportation, and the environment. (Shows ripple effect and collective impact of housing interventions)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of housing assistance programs for pregnant and postpartum individuals that are designed, implemented, and evaluated with substantive leadership and decision-making power from directly impacted individuals and communities. (Measures depth of community ownership and governance of housing interventions)
  • Percent of housing and maternal health leaders, policymakers, and other key partners collaborating with Title V who demonstrate increased commitment to advancing housing and reproductive as interconnected priorities and shared responsibilities. (Shows transformation in mindsets and power structures underlying housing challenges)
  • Percent of neighborhoods and communities that experience reduced rates of adverse birth outcomes and maternal morbidity as a result of tailored housing investments and supports for pregnant and postpartum women. (Assesses community-level impact of housing interventions)
  • Percent of cross-sector initiatives and partnerships catalyzed by housing assistance programs to address the intersecting root causes of maternal and child health, such as education, transportation, and environmental . (Shows ripple effect and collective impact of housing interventions)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Muchomba, F. M., Teitler, J., & Reichman, N. E. (2022). Association between housing affordability and severe maternal morbidity. JAMA network open, 5(11), e2243225-e2243225.
[2] Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S., Heeren, T., Black, M. M., ... & Frank, D. A. (2018). Timing and duration of pre-and postnatal homelessness and the health of young children. Pediatrics, 142(4).

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.